Ramblings of an Emergency Physician in Texas

In the mailbag comes this letter, asking for advice about whether / how to report physician impairment. I’ve modified it so neither the sender nor the subject can be identified.

Put this down as a ?nobody asked me, but??

I stumbled onto your Blog, and enjoy it. Its content leads me to believe you would be in a position to comment on a dilemma I recently faced in an emergency room recently. My HMO requires that I use an ER when I need medical help, even for conditions of a non-urgent nature. Hit with the excruciating pain and discomfort …, I went to the local ER around midnight on a Friday night and sat there waiting for close to five hours, mixed in with the usual assortment of drunks, druggies, and drifters that seem to inhabit ER waiting rooms these days.

I finally got to see the MD, who diagnosed and treated the condition. What struck me, and what lead to this missive was the fact that when he came into my examination room, the unmistakable aroma of scotch preceded him. My diagnosis of his breath odor was confirmed as he worked on me.

I am not a prude, and have probably (certainly) imbibed more than my allotment of scotch in my years, but I do believe there is a time and place for everything, and on the breath of an ER MD on duty at 5:00 AM is not one of them. My experience has taught me that booze, even in minute quantities, tends to dull one?s mental acuity, something that can lead to mistakes. I did not challenge the man at the time, but I have been seized with doubts since.

What is the protocol in such circumstance? Challenge the MD on the spot? Report him to the hospital administrators? Or do as I did, nothing?

Your thoughts would be appreciated.

Challenging the doctor on the spot, though the most direct option, is probably not the best way to handle the problem. I think the best way to approach this would be to ask, politely, to speak with the hospital administrator, and barring that, to speak with the charge nurse of the ED. Make your concerns known, then, when your doctor in question is still there. They would then be a) aware and b) on alert that a patient had made this complaint.

Proximity to the event (doing it while you and the doctor are both there) would have been best, as the medical staff could have taken steps to confirm or refute your concerns. (There are limits to Medical Staff powers here: they cannot force a doc to have a blood draw, piddle in a cup, etc, but can suspend a doctor for ‘conduct’ that requires no such proof) (but does require a medical staff that’s well-covered against suits from the doc).

Uniquely, ER docs are the easiest for a hospital to get rid of (the vast majority of us can have our medical staff privileges revoked without appeal as part of our contracts), so that would certainly embolden the medical staff to act where the might be more reluctant to suspend their only brain surgeon, for instance.

At this point the only thing to do is write a nice, polite "I thought you’d want to know…" letter to the hospital president. Unfortunately, you’re then in a he said / I said loop, and the doc might be able to sue you (please consult an attorney before writing this letter: I’m not an attorney, and the only advice I’m giving to you at this point is "talk to a lawyer"). However, this is behavior that need to be reported, and you’re right, there’s no room for drinking on the job (even if it does make you ‘fit in’ with most of your evening patients).